1. Paediatric Cardiology
Valmiki K. Seecheran.
Year V MBBS
06/05/2014

2. Fetal circulation.
• Fetus.
– Placenta is the oxygenator; lungs do little work.
• Shunts necessary for survival.
– Ductus venosus – by pass liver.
– Foramen ovale – R-L atrial shunt.
– Ductus arteriosus – R-L arterial shunt.
• RV & LV contribute equally to systemic
circulation.
06/05/2014

3. Transitional circulation.
• Birth.
– 1st few breaths, lungs expand and serves as
oxygenator.
– Foramen ovale functionally closes.
– Ductus arteriosus usually closes within 1-2 days.
06/05/2014

4. Neonatal Circulation.
• RV pumps to pulmonary circulation and LV
pumps to systemic circulation.
• By 6 weeks pulmonary resistance drops and LV
becomes dominant.
06/05/2014

5. Pediatric Circulation.
• RV is a more compliant chamber than LV.
• LV pressure is 4-5x RV pressure.
– RV pumps against lower resistance than LV.
06/05/2014

6. Congenital Heart Disease.
• 0.5 – 1% of live births.
• Classification
– L-R shunts.
– Cyanotic CHD (R-L) shunts.
– Obstructive lesions.
06/05/2014

7. ‘Acyanotic CHD’ – L-R shunts.
• VSD
– Infancy.
– Heart Failure, murmurs & FTT.
• PDA
– Infancy.
– Heart Failure, murmurs & FTT.
• ASD
– Childhood/ Exercsise intolerance.
– Right heart enlargement.
– Transmits flow only.
• AVSD
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8. 06/05/2014

9. Eisenmenger’s Syndrome.
• L-R shunt.
– Irresversible pulmonary vascular disease.
– Unrepaired VSD’s & PDA’s due to high pressure.
– PVR high, the shunt reverses, becomes R-L and
patient becomes cyanotic.
06/05/2014

10. R-L Shunts.
• Classified based on pulmonary blood flow:
1. Increased PBF (pulmonary blood flow).
– Transposition of great arteries.
– Truncus arteriosus.
– Total anamalous pulm return.
2. Decreased PBF (pulmonary blood flow).
– Tetraology of Fallot.
– Tricuspid atresia.
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11. R-L Shunts.
• Increased PBF.
– Presents often with heart failure.
– Pulmonary congestion worsens as neonatal PVR
decreases.
– P02 can be 93-94%.
06/05/2014

12. R-L Shunts.
• Decreased PBF.
– Cyanosis.
– Closure of PDA may worsen cyanosis.
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13. 06/05/2014

14. Innocent murmurs.
• Peripheral pulmonic stenosis.
– Newborns – disappears by 1 year of age.
– ULSB – best heard in axilla/back.
– Differentiate between PS – associated with a
valvular click and heard best of precordium.
06/05/2014

15. Innocent murmurs.
• Still’s murmur.
– Classic.
– 3-5 years commonly.
– Vibratory – heard along LSB and apex.
– Increased in intensity when patient is supine/
patient in high output states (fever, dehydration).
– Differentiate from VSD.
06/05/2014

16. Syndrome Associations.
• Down’s Syndrome – AV canal & VSD.
• Turner’s Syndrome – CoA & AS.
• Trisomies 13 & 18 – VSD & PDA.
• Fetal Alcohol Syndrome – L-R shunt, ToF.
06/05/2014

17. Kawasaki Disease.
• #1 cause of acquired heart disease.
• Autoimmune & < 5 years of age.
• System vasculilitis (necrotizing); veins & arteries. –
idiopathic.
• Work up.
– CBC, U&E, CRP, ESR, EKG, ECHO.
• Treatment.
– IVIG, Salicylate therapy, Aspirin, Corticosteroids.
• Prognosis.
– Coronary artery dilation 25% w/o IVIG and 5% w/IVIG.
– Frequent ECHOs.
06/05/2014

18. Kawasaki Disease
• Clinical Criteria – Fever for atleast 5 days and 4
of the following 5 parameters:
– Eyes – conjuctivial injection.
– Lips & mouth – erythema, cracked lips, strawberry
tongue.
– Hands & feet – edema/ erythema.
– Skin – rash.
– Unilateral, cervical lyphadenopathy.
06/05/2014

19. Rheumatic Fever
• Post infectious connective tissue disease
• Antibody cross-reactivity – Group A Strep.
• Work up
– Throat Cx, CRP, ESR, EKG, ECHO.
– Jones criteria.
• Major – Polyarthritis, Carditis, Nodules, Erythema
marginatum.
• Minor – Fever, Arthralgia, Raised ESR, Leukocytosis,
prolonged PR interval.
• Treatment
– Aspirin, corticosteroids, Penicillin.
06/05/2014

20. Thank you.
06/05/2014